Texas inquires about Medicaid expansion while Arizona faces challenge

Another GOP-led state has inquired about Medicaid expansion, while Arizona faces a renewed challenge to its existing expansion program.

Texas Gov.-elect Greg Abott reportedly asked for more information in late December about Utah’s customized Medicaid expansion program, according to the Houston Chronicle. Abbott, the long-time attorney general of Texas, has been an outspoken critic of the Affordable care Act (ACA). He joined other U.S. Attorneys’ General in an unsuccessful challenge to the law that was heard by the Supreme Court in 2012, and campaigned against Medicaid expansion in the governor’s race.

To date the GOP-led state has rebuffed all attempts at expansion. But while the legislature is firmly against expansion, financially-strapped Texas hospitals have been lobbying for a compromise.

Abbot reportedly inquired about Utah’s recent customized Medicaid expansion option, Healthy Utah, which was unveiled by Republican Gov. Gary Herbert in early December. The plan will bring coverage to 65,000 Utah residents now in the coverage gap whose income is too high for current Medicaid guidelines program and too low to qualify for tax subsidies. Texas has nearly 1 million residents who are in the coverage gap, according to the Kaiser Family Foundation.

In Arizona, which has already impemented Medicaid expansion, the program faces a renewed challenge. Arizona’s Supreme Court has ruled that Republican lawmakers can challenge the legality of the law’s hospital assessment, according to the Associated Press. At issue is whether the hospital assessment is a tax requiring a two-thirds majority vote. Outgoing Republican Gov. Jan Brewer pushed expansion through in a special session in June of 2013 with little Republican support.

 "Today's ruling places all of this at risk - threatening life-saving health coverage for Arizona families and potentially blowing an even larger hole in our State budget," Greg Vigdor, CEO of the Arizona Hospital and Healthcare Association, said in a statement. "On behalf of Arizona hospitals, AzHHA asks Gov.-elect Ducey to continue a strong defense of the Medicaid Restoration."

Since the mid-term elections, several more states have signaled interest in expanding Medicaid including Tennessee, Alabama and Florida, while Alaska and Wyoming are working on a customized expansion plan.

Twenty-eight states including the District of Columbia have received approval from the Centers for Medicare and Medicaid Services (CMS) to expand Medicaid since the U.S Supreme Court decision in June 2012 made expansion a state option.

As of December 2014, four of those states have implemented a customized expansion option: Pennsylvania, Michigan, Arkansas, and Iowa. CMS is currently reviewing a waiver proposal for Indiana, while Utah has received preliminary approval for its waiver proposal.